About bowel cancer treatment – TME

There is evidence in the medical literature that colorectal cancer is the most technique-dependent of all malignancies. In other words, there is greater difference in outcome in terms of cure, the number of permanent colostomies necessary and in other disabilities, including impaired sexual function, as a result of treatment technique than for any other cancer.

Precise bowel cancer surgery, particularly the Total Mesorectal Excision (TME) technique, saves more lives than any other treatment for low bowel cancer. It halves the chance of the cancer returning and minimises negative side effects such as damage to urinary and sexual function. TME has already made a life-saving, life-enhancing difference to thousands of patients all over the world.

The TME technique was developed by Pelican’s founder Professor Bill Heald at the Hampshire Hospitals NHS Foundation Trust’s Basingstoke and North Hampshire Hospital, and is recognised as the ‘gold standard’ in rectal cancer surgery worldwide. It is now adopted by surgeons across the UK, and formally adopted in Norway, Sweden, Denmark, Holland, Germany, Austria and Switzerland. The technique has become standard terminology for optimal treatment of pelvic cancer all over the world.

What is TME? TME is precise surgery – the surgeon takes his/her time to meticulously remove the part of the bowel where the tumour is sited and also includes all of the surrounding tissue (the mesorectum). It is evident from pictures of the tumour specimen after surgery when this is successfully achieved – when the surgeon has carefully followed the ‘planes of surgery’ and removed the tumour with a shiny and complete outer layer. When the specimen is irregular or damaged then the ‘margins’ may be compromised – this can lead to a recurrence of the cancer as cells might have been released into the body.

Between 2003-06, Pelican ran a National Training Programme for multi-disciplinary cancer teams across England to learn about improving treatment using TME within an effective multidisciplinary team setting. Over 2,000 clinicians attended the courses, and this programme continues with courses by Prof Heald and Mr Brendan Moran every year. In 2011, the National Cancer Action Team (NCAT) launched the Low Rectal Development Programme (LOREC) with Mr Moran as the National Clinical Lead, again run by Pelican, which focuses on the complexities of treating very low rectal cancers.

Laparoscopic surgery (minimally-invasive surgery) for bowel cancer is growing in importance and NICE guidelines now specify that suitable patients must be offered laparoscopic surgery. There are obvious advantages in not having a large scar in the abdomen and healing times are faster, but it should also be remembered that laparoscopic surgery is a tool, not a religion – and it is not always the best solution for every patient. Pelican in Basingstoke is one of the national training centres for the LAPCO programme.

The da Vinci robot is now used for TME surgery in a number of units. This is another form of minimally-invasive surgery which may give a superior view of the operating area and a very precise dissection of the ‘TME’ nerves. However the procedure takes longer and surgeons require time to become proficient.